Page 116 - THE EVOLUTION OF EARLY ARTHRITIS AND CARDIOVASCULAR RISK Samina A. Turk

CHAPTER 6
ABSTRACT
OBJECTIVES. To determine if cardiovascular (CV) risk scores, traditional risk factors and the resulting indication for preventive treatment change after initiation of anti- rheumatic treatment in early rheumatoid arthritis (RA) patients.
METHODS. Disease activity, blood pressure, acute phase proteins and lipid profile were evaluated in early RA patients at baseline and after four weeks of anti-rheumatic treatment. CV risk scores (Dutch Systematic Coronary Risk Evaluation (SCORE) and European Heart SCORE) and indication for preventive CV treatment (according to the Dutch CV risk management guidelines) were determined.
RESULTS. One hundred and four consecutive RA patients were included, 7% had a history of CV disease. At baseline, 29.9% and 3.1% were classified as high risk according to the Dutch SCORE and Heart SCORE, respectively. According to the Dutch CV- risk management guidelines that use the Dutch SCORE, all high risk patients had at baseline an indication for (adaptations of) preventive treatment. From the CV risk score the components blood pressure and TC:HDL ratio decreased during anti-rheumatic treatment and 9% of the patients switched their CV risk category. In total 13% of the patients had a change in advice for preventive CV treatment after one month of anti- rheumatic treatment.
CONCLUSION. CV risk management is important in RA patients, however the timing of assessment, as well as the use of a particular CV risk model, influences the advice about the need for CV preventive treatment. Further research is needed to determine which risk model is optimal and when in the course of RA it should be applied.
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